RN Case Manager, Telehealth-Remote at Navitus Health Solutions Full Time

Job Duties and Responsibilities

• Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS).
• Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services.
• Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines.
• Develop documentation standards for all clinical outreaches.
• Collaborate with other CEC staff to develop and maintain a high quality and consistent MTM product.
• Assist CEC leadership to develop program to support STAR ratings outreach.
• Facilitate communication and education to clients, providers, and internal staff regarding MTM programs and program outcomes.
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
• Provide Medicare Part D clinical, operational, and educational support by maintaining knowledge of all existing updates and regulations regarding the MTM program and Medicare Part C and D performance measures (STAR ratings).
• Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into the MTM and STARs programs, such that our clinical outreaches remain up to date.

Requirements

• Registered Nurse with unrestricted licensure
• Two years clinical experience including direct consultation experience preferred.
• Experience as a member of a multi-disciplinary team is preferred.
• Professional PBM industry work experience is preferred.
• Knowledge of applicable data privacy practices and laws is preferred.
• Knowledge of healthcare industry practices and HIPAA regulations.
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Benefits

• Hours/Location: Monday-Thursday 10:30am-7:00pm CST and Friday 8:30am-5:00pm CST, Remote
• Paid Volunteer Hours
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!
• Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program